AB1182 EFFECTIVENESS OF FATIGUE INTERVENTIONS IN OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: H. Fawole, O. Osadiaye, O. Idowu, O. Akinrolie, M. Ibekaku, M. Ojo, A. Oyeyemi, J. Riskowski
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Pain and physical function are common factors targeted for osteoarthritis (OA) management. However, fatigue has been reported as an important component of OA experience and a significant concern for people with OA (Power et al., 2008). Despite this, fatigue has received very little attention. However, with increasing interests in fatigue, it is expedient that fatigue be considered a top priority in clinical practice (Overman et al., 2016). Thus, there is dire need for evidence-based fatigue interventions in OA given the paucity of evidence in this area. <h3>Objectives</h3> To identify fatigue interventions and determine the effectiveness of the interventions in reducing fatigue immediately and over time in OA. <h3>Methods</h3> A review protocol was developed and registered with the PROSPERO database, with the ID-CRD42020163730. Studies included comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of any intervention in the management of fatigue or vitality outcomes in people with upper limb and lower limb OA. Studies that used spiritual, pharmacological or surgical interventions to manage fatigue in patients with upper limb and lower limb OA were excluded. The Cochrane Collaboration's tool for assessing the risk of bias (ROB) was used assess the quality of evidence for the included RCTs. Narrative synthesis was used to summarise the identified fatigue interventions while only studies on exercise interventions were used in the meta-analysis. <h3>Results</h3> Out of 2,586 studies identified from database search, 31 RCTs studies were included after screening for titles, abstracts and full texts. Of the 31 included RCTs, only nine studies were included in the meta-analysis comparing the effects of exercise versus non-exercise interventions on fatigue. From the ROB assessment, 11 RCTs were of low ROB whilst 11 had moderate and 9 high ROB respectively. The narrative synthesis identified 12 interventions for fatigue and these include activity pacing, cognitive behavioural therapy (CBT), yoga, exercise, acupuncture, moxibustion, pain-coping skills, BEMER therapy, modified shoes, massage/aromatherapy, education and thermotherapy. Exercises interventions included strengthening, balance, kinesthesia, and mobilization, hand-based, stretching, aquatic danced-based and web-based exercises. Activity pacing (mean difference [MD]=0.8; (standard deviation [SD]=0.3), CBT (MD=4.32; [SD]=1.85), moxibustion (vitality: MD=-2.61; [standard error]=-1.69) had statistically significant reductive immediate effect on fatigue. The meta-analysis pooled effects showed that exercise interventions on fatigue in OA was not statistically significant both immediately (SMD=-0.10; 95% CI -0.74, 0.54; I<sup>2</sup>=94%) and overtime (SMD=-0.79; 95% CI -2.30, 0.73; I<sup>2</sup>=98%), although the effects was in favour of exercise interventions relative to other comparison non-exercise interventions. <h3>Conclusion</h3> Activity pacing, CBT and moxibustion interventions showed beneficial effects on fatigue in OA immediately. Cumulatively, the pooled effect of exercise on fatigue was not statistically significant immediately and overtime but the effect was in favour of the exercise interventions relative to other control interventions. However, there is currently insufficient evidence regarding the effectiveness of majority of identified fatigue interventions in this review. Further, the findings of the meta-analysis may have been affected by high level of heterogeneity. Largely populated RCTs with low ROB are needed to ascertain the effectiveness of fatigue interventions in OA population. <h3>References</h3> [1]Power JD, Badley EM, French MR, Wall AJ, Hawker GA., 2008. Fatigue in osteoarthritis: a qualitative study. BMC Musculoskelet Disord. 9(1):63. doi:10.1186/1471-2474-9-63 [2]Overman CL, Kool MB, Da Silva JA, Geenen R. 2016. The prevalence of fatigue in rheumatic disease: An international study. Clin Rheumatol.25(2), 409-415. doi.10.1007/s10067-015-3035-6 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.